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The effects of regional characteristics on alcohol-related mortality--a register-based multilevel analysis of 1.1 million men

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  • Blomgren, Jenni
  • Martikainen, Pekka
  • Mäkelä, Pia
  • Valkonen, Tapani

Abstract

The aim of this study is to assess to what extent selected characteristics of functional regions affect alcohol-related mortality among men in Finland after adjusting for individual-level characteristics. The study was conducted as a multilevel Poisson regression analysis, with individuals (n=1.1Â million) as the first level and functional regions of Finland (n=84) as the second level. The analysis covered men aged 25-64. The data are based on the 1990 census records, which were linked to death records in 1991-1996. The outcome measure was alcohol-related mortality, which was defined using information on the underlying and contributory causes of death. The individual-level covariates included age, education, socioeconomic status, marital status and mother tongue. The area-level variables considered were the proportion of manual workers, unemployment level, median household income, Gini coefficient of income, family cohesion, voting turnout, level of urbanisation and proportion of Swedish-speaking inhabitants. A high proportion of manual workers and of unemployed and low social cohesion (family cohesion and voting turnout) were found to produce adverse effects on alcohol-related mortality, and the independent effects of these variables remained after adjustment for all individual-level and area-level characteristics. The protective effect of high level of urbanisation was revealed after adjustment for other individual- and area-level characteristics. Neither mean income nor income inequality were related to alcohol-related mortality. Adjusting for individual-level variables diminished the average relative deviation of alcohol-related mortality among the functional regions by 41%. The inclusion of area-level characteristics in the model resulted in a total diminution of variation of 79%. The area characteristics considered in this study had a notable effect on alcohol-related mortality, although these effects were smaller than those of the individual-level characteristics. Fuller understanding of the mechanisms underlying the effects of area measures of social structure and cohesion on risky alcohol consumption and alcohol-related mortality is needed.

Suggested Citation

  • Blomgren, Jenni & Martikainen, Pekka & Mäkelä, Pia & Valkonen, Tapani, 2004. "The effects of regional characteristics on alcohol-related mortality--a register-based multilevel analysis of 1.1 million men," Social Science & Medicine, Elsevier, vol. 58(12), pages 2523-2535, June.
    • Handle: RePEc:eee:socmed:v:58:y:2004:i:12:p:2523-2535
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    1. Hannes Kröger & Rasmus Hoffmann & Lasse Tarkiainen & Pekka Martikainen, 2018. "Comparing Observed and Unobserved Components of Childhood: Evidence From Finnish Register Data on Midlife Mortality From Siblings and Their Parents," Demography, Springer;Population Association of America (PAA), vol. 55(1), pages 295-318, February.
    2. Bowling, Ann & Stafford, Mai, 2007. "How do objective and subjective assessments of neighbourhood influence social and physical functioning in older age? Findings from a British survey of ageing," Social Science & Medicine, Elsevier, vol. 64(12), pages 2533-2549, June.
    3. Feng, Zhixin & Wang, Wenfei Winnie & Jones, Kelvyn & Li, Yaqing, 2012. "An exploratory multilevel analysis of income, income inequality and self-rated health of the elderly in China," Social Science & Medicine, Elsevier, vol. 75(12), pages 2481-2492.
    4. Kravdal, Øystein, 2009. "Mortality effects of average education in current and earlier municipality of residence among internal migrants, net of their own education," Social Science & Medicine, Elsevier, vol. 69(10), pages 1484-1492, November.
    5. Celine Saul & Shannon Lange & Charlotte Probst, 2022. "Employment Status and Alcohol-Attributable Mortality Risk—A Systematic Review and Meta-Analysis," IJERPH, MDPI, vol. 19(12), pages 1-10, June.
    6. Jirapramukpitak, Tawanchai & Abas, Melanie & Tangchonlatip, Kanchana & Punpuing, Sureeporn, 2014. "The effect of asset-based wealth inequality on problem drinking among rural Thai elders: A prospective population-based cohort study," Social Science & Medicine, Elsevier, vol. 100(C), pages 107-114.
    7. Kravdal, Øystein, 2008. "A broader perspective on education and mortality: Are we influenced by other people's education?," Social Science & Medicine, Elsevier, vol. 66(3), pages 620-636, February.
    8. Henriksson, Göran & Weitoft, Gunilla Ringbäck & Allebeck, Peter, 2010. "Associations between income inequality at municipality level and health depend on context - A multilevel analysis on myocardial infarction in Sweden," Social Science & Medicine, Elsevier, vol. 71(6), pages 1141-1149, September.
    9. Dahl, Espen & Ivar Elstad, Jon & Hofoss, Dag & Martin-Mollard, Melissa, 2006. "For whom is income inequality most harmful? A multi-level analysis of income inequality and mortality in Norway," Social Science & Medicine, Elsevier, vol. 63(10), pages 2562-2574, November.
    10. Murayama, Hiroshi & Wakui, Tomoko & Arami, Reiko & Sugawara, Ikuko & Yoshie, Satoru, 2012. "Contextual effect of different components of social capital on health in a suburban city of the greater Tokyo area: A multilevel analysis," Social Science & Medicine, Elsevier, vol. 75(12), pages 2472-2480.
    11. Nancy A. Ross & Lisa N. Oliver & Paul J. Villeneuve, 2013. "The Contribution of Neighbourhood Material and Social Deprivation to Survival: A 22-Year Follow-up of More than 500,000 Canadians," IJERPH, MDPI, vol. 10(4), pages 1-14, April.
    12. Rostila, Mikael & Kölegård, Maria L. & Fritzell, Johan, 2012. "Income inequality and self-rated health in Stockholm, Sweden: A test of the ‘income inequality hypothesis’ on two levels of aggregation," Social Science & Medicine, Elsevier, vol. 74(7), pages 1091-1098.
    13. Pavel Grigoriev & Domantas Jasilionis & Daumantas Stumbrys & Vladislava Stankūnienė & Vladimir M Shkolnikov, 2017. "Individual- and area-level characteristics associated with alcohol-related mortality among adult Lithuanian males: A multilevel analysis based on census-linked data," PLOS ONE, Public Library of Science, vol. 12(7), pages 1-14, July.
    14. Elo, Irma T. & Martikainen, Pekka & Myrskylä, Mikko, 2014. "Socioeconomic status across the life course and all-cause and cause-specific mortality in Finland," Social Science & Medicine, Elsevier, vol. 119(C), pages 198-206.
    15. Meijer, Mathias & Röhl, Jeannette & Bloomfield, Kim & Grittner, Ulrike, 2012. "Do neighborhoods affect individual mortality? A systematic review and meta-analysis of multilevel studies," Social Science & Medicine, Elsevier, vol. 74(8), pages 1204-1212.
    16. Jokela, Markus & Kivimäki, Mika & Elovainio, Marko & Viikari, Jorma & Raitakari, Olli T. & Keltikangas-Järvinen, Liisa, 2009. "Urban/rural differences in body weight: Evidence for social selection and causation hypotheses in Finland," Social Science & Medicine, Elsevier, vol. 68(5), pages 867-875, March.

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